A sudden death case due to untreated massive mucinous cystadenoma of the ovary

We herein report a case of sudden death from massive mucinous cystadenoma of the ovary. A female in her 70s was found dead with an enlarged abdomen. Forensic autopsy was performed to identify the cause of death. Postmortem computed tomography showed a large amount of intra-abdominal fluid pushing against intraperitoneal organs. The deceased was 152 cm in height and weighed 85 kg. The abdomen was enlarged with a girth of 133 cm. A left ovarian cyst was detected and contained 32 L of a dark brown fluid. The uterus and ovaries weighed 1200 g. The heart weighed 400 g, and atherosclerosis was noted in the left coronary artery and aorta. The pathophysiological mechanisms leading to death were considered to be multifactorial. The massive ovarian cyst increased intra-abdominal pressure and produced a cephalic shift in the diaphragm. This may have had a negative impact on the cardiovascular and respiratory systems by (a) increasing the heart rate, (b) decreasing lung compliance, (c) increasing the respiratory rate, (d) increasing maximum inspiratory pressure, (e) increasing mean arterial pressure and systemic vascular resistance, (f) reducing femoral venous return, (g) compressing the inferior vena cava, and (h) decreasing venous return. This, in turn, increased susceptibility to hypoxia in addition to the underlying ischemic heart disease. We diagnosed the cause of death as acute circulation failure due to myocardial ischemia based on intra-abdominal hypertension as a result of the massive ovarian cyst.